Kudzivirira uye Kuchengeta Intraoperative Hypothermia - Chikamu 1

Kudzivirira uye Kuchengeta Intraoperative Hypothermia - Chikamu 1

I. Pfungwa ye hypothermia:

• Core tembiricha iri pasi pe36 ℃ ndiyo hypothermia

• Core tembiricha tembiricha iri mumuviri wepulmonary artery, tympanic membrane, esophagus, nasopharynx, rectum uye dundira, nezvimwe.

• Perioperative hypothermia (Inadvertentperioperative hypothermia, IPH), Mild hypothermia inogona kuitika mu50% -70% yeanesthesiology uye varwere vekuvhiya.

II. Hypothermia grading:

• Mukiriniki, kupisa kwepakati kwe34 ℃-36 ℃ kunowanzo kunzi mild hypothermia.

• 34 ℃-30 ℃ seyakadzika hypothermia

• 30 ℃-28 ℃ ine mwero hypothermia

• <20 ℃ yeyakadzika hypothermia

• <15 ℃ ultra-deep hypothermia

III. Zvikonzero zve intraoperative hypothermia

(I) Kuzvikonzera:

A. Zera:

Vakuru:  Yakashata thermoregulation basa (muscle thinning, low muscle tone, ganda ropa, tube contractile strain strain capacity yakaderera, low cardiovascular reserve function).

Vana vanozvarwa nguva isati yakwana, vacheche vanozvarwa vane huremu hushoma:  Nzvimbo yekurapa haina kuvandudzwa.

B. Muviri (mafuta emuviri)

Mafuta insulator yakasimba yekupisa, inogona kudzivirira kurasikirwa kwekupisa kwemuviri.

Masero emafuta ese anogona kuona tembiricha, uye anopisa nekuburitsa simba. Chidzidzo cheHarvard University chakawana kuti kudziyisa uku kunoenderana neprotein inonzi coupling protein-1. Kana muviri uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchi .

Mumamiriro ezvinhu akajairika, varwere vanoda kutsanya kwemaawa angangoita gumi nemaviri vasati vavhiyiwa. Kana kusimba kwavo kwemuviri kwakashata, ivo vanozonyanya kunzwira kutonhora kukurudzira, zvichikonzera kushomeka kwekudzivirira. Kukurudzira kutonhora kunokonzerwa nekuvhiyiwa kunogona kukonzera kupisa kwemuviri kudonha.

C. Mamiriro ezvinhu

Kuchinja-chinja kwemanzwiro emurwere sekutya, kushushikana, uye kufunganya kunoita kuti ropa rigoverwe, zvichikanganisa kudzoka kweropa kumoyo uye microcirculation, uye zviri nyore kukonzera hypothermia panguva yekuvhiya.

D. Chirwere chakakomba

Kurwara zvakanyanya, kuperevedza zvakanyanya: yakaderera kupisa kupisa kugona.

Kukanganisa kutendeseka kweganda: kukuvadzwa kukuru, maronda ekudzikisa, kupisa kwakanyanya.

(II)Zvakatipoteredza

Tembiricha mukamuri yekuvhiya kazhinji inodzorwa pa21-25 ° C. pasi pekushisa kwemuviri.

Kupisa kwakajairika kwekamuri yekushanda yelaminar uye kukurumidza kutenderera kwemhepo yemukati kuchawedzera kupisa kwemuviri wemurwere, izvo zvinowanzokonzera kupisa kwemuviri wemurwere kudonha.

(III)Kubvisa kupisa kwemuviri

A. Skin disinfection:

Kupisa kwemushonga wekuuraya utachiona kwakadzikira, uye chinangwa chekuuraya utachiona chinogona kuwanikwa chete mushure mekunge disinfection yaoma. Kupisa kwemushonga wekuuraya utachiona kunobvisa kupisa kwakawanda uye kunoderedza tembiricha yemuviri.

B. Kugezesa kwakanyanya:

Kugeza nesaline yakawanda yakajairika kana mvura yejekiseni panguva yekuvhiya kunoitawo kuti muviri urasikirwe nekupisa, ndicho chikonzero chekuti kupisa kwemuviri wemurwere kudonha.

C. Kuvhiyiwa kukuru kunotora nguva yakareba, uye nguva yekuratidzwa kwechipfuva uye nhengo dzedumbu dzakareba

D. Vashandi vezvokurapa havana ruzivo rwekuchengetedza kupisa

IV.Nyevedzo

Zvinodhaka zvinogona kushandura nzvimbo yakatarwa ye thermoregulatory center.

General anesthesia - yakawanda yeanesthetics inogona kutambanudza zvakananga tsinga dzeropa, uye zvinozorodza tsandanyama zvinogona kutadzisa kupindura kubvunda.

Regional block anesthesia - the afferent fibers of peripheral cold sensation yakavharwa, kuitira kuti pakati anotenda zvisiri izvo kuti nzvimbo yakavharwa inodziya.

V. Mvura uye kuwedzerwa ropa

Kuiswa kwehuwandu hwemvura uye ropa remutoro patembiricha yekamuri imwechete kana kuwanda kwemvura inoyerera patembiricha yekamuri panguva yekuvhiya kuchaita mhedzisiro ye 'cold dilution' uye kukonzera hypothermia.

Intravenous infusion ye1L yemvura patembiricha yekamuri kana 1 unit ye4C yeropa muvakuru inogona kuderedza kupisa kwepakati pemuviri neinenge 0.25°C.

Zvakatorwa kubva: Wu Zhimin. Yue Yuan. Tsvagiridzo uye Nursing yeHypothermia Panguva Yechiropa Transplantation Anesthesia Operation]. Chinese Journal of Practical Nursing, 2005